Dr. Ravishankar Asokkumar, MBBS, MRCP, FRCP, FASGE

Dr. Ravishankar Asokkumar, MBBS, MRCP, FRCP, FASGE



1/ There is a confusion between early vs advanced cancer & Superficial vs Deep Ca πŸ‘‰ Early Ca-Invasion depth to submucosa only, irrespective of nodal status πŸ‘‰ Advanced Ca- invasion beyond submucosa with regional nodes or distant metastasis #GITwitter #MedTwitter #Gastroresidents

2/ Superficial lesions- those that are believed to be endoscopically resectable Deep lesions- those that are deemed β€œtoo deep” to be scooped, and thus endoscopically unresectable #GIFellows #ACG #Tweetorial

3/ The decision for endoscopic resection is based on combination of morphological and advanced imaging appearance (NBI/Chromo) @giendo_roy High Risk for Submucosal Invasion πŸ‘Ž Depressed lesion πŸ‘Ž Kudo V pit pattern πŸ‘Ž NICE 3 pattern πŸ‘Ž Fold convergence πŸ‘Ž Non-lifting sign

4/After endoscopic treatment, curative or non-curative resection is established based on histology Curative cut πŸ‘Well or mod differentiated πŸ‘Good lateral margins (>1mm) πŸ‘Confined to superficial submucosa (<1mm)(Level3 in polypoid lesion) πŸ‘No LV involvement πŸ‘No tumor budding

5/There are numerous facts that we use reflexively when assessing the malignant potential of a polyp. At times, a single finding is enough to diagnose SM invasion. Other times, combination two or more findings needed for diagnosis. How we use these information in decision making

When assessing the potential for invasive cancer, because of our difficulty to combine the specificities of different findings, our decisions are skewed by heuristics and biases. To understand more on system thinking and overcoming biases, checkout

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